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Biomedical subjects

S Valentine

Publications and source records attributed to S Valentine.

At least 19 recordsLinked to original sources
PubMed1999

The effect of different bypass flow rates and low-dose dopamine on gut mucosal perfusion and outcome in cardiac surgical patients.

The aim of this double-blind, randomized, placebo-controlled trial was to investigate the effects of different cardiopulmonary bypass flow rates and low-dose dopamine on gastric mucosal pH (pHi) and outcome. We hypothesized that by minimizing gut mucosal hypoperfusion during and after cardiac surgery endotoxin translocation may be prevented, resulting in an improved clinical outcome. Four groups of 25 patients each receiving high or low flows during bypass and low-dose dopamine or saline for 24 hours after induction of anaesthesia were studied. The pHi was measured at six time intervals over 24 hours. The combination of low-dose dopamine and a low bypass flow rate was associated with a significantly greater frequency and severity of low pHi. This group also demonstrated a significantly lower vascular resistance on admission to the intensive care unit. There may be an association between low pHi and low vascular resistance.

Cardiopulmonary Bypass↗
PubMed1998

Comparison of wound care practices in pediatric and adult lacerations repaired in the emergency department.

OBJECTIVE: We compared emergency physician's wound care practices in young children (< or = 5 years) and adults (> or = 18 years) and the effect of these different practices on infection rate and cosmetic appearance. DESIGN: Cross sectional study. SETTING: University hospital emergency department that rarely uses conscious sedation. PARTICIPANTS: Consecutive patients who presented with lacerations over a four-year period. METHODS: Structured closed question data sheets that assessed 26 separate wound characteristics were prospectively completed at initial presentation and at suture removal. Infection and cosmetic appearance were assessed with previously validated scales. chi(2) tests were used for categorical variables, t tests for continuous variables. RESULTS: We evaluated 3624 patients: 853 children and 2771 adults. Wounds in children were more likely to be on the head (86 vs 38%, P < 0.01); linear (88 vs 77%, P < 0.01); shorter (1.9 vs 3.0 cm, P < 0.01); less often contaminated (4 vs 11%, P < 0.01); and more commonly caused by blunt injury (69 vs 37%, P < 0.01). With respect to treatment, lacerations in children were less likely to receive irrigation (53 vs 77%; P < 0.001) but slightly more likely to be scrubbed (50 vs 45%, P = 0.01). The two groups received similar numbers of sutures per centimeter (2.6 vs 2.3). Using logistic regression, the differences in irrigation were not explained by the differences in laceration characteristics. Despite less frequent irrigation, children had lower wound infection rates (2.1 vs 4.1%; P = 0.004) and better cosmetic appearances (optimal score, 75 vs 64%, P = 0.0003). CONCLUSIONS: Emergency physicians at our institution are less likely to irrigate lacerations in children than adults; however, children had a lower infection rate and more favorable cosmetic outcome.

Adult↗
PubMed1996

Acute renal failure in cardiac surgical patients, potentiated by gentamicin and calcium.

A retrospective study in coronary artery bypass graft patients was undertaken to assess the effect of gentamicin and a bypass prime with a high calcium on the incidence of renal failure. Patients who received both Haemaccel (polygeline, Hoechst Marion Roussel) (calcium concentration 6.25 mmol/l) in the bypass prime and gentamicin perioperatively had a higher incidence of renal failure compared with those who received only Haemaccel (P = 0.005), only gentamicin (P = 0.002) or neither (P = 0.0001). We suggest that the combination be avoided in this group of patients.

Acute Kidney Injury↗
PubMed1995

Wound registry: development and validation.

STUDY OBJECTIVE: More than 11 million patients with traumatic wounds are seen annually in emergency departments. We developed and validated a data registry for traumatic wounds treated in the ED. DESIGN: Prospective, consecutive patient enrollment with a validation cohort of a convenience sample of 100 patients. SETTING: University-affiliated hospital ED. PARTICIPANTS: For all patients with traumatic wounds requiring sutures, wound registry data sheets were completed at the time of initial visit using a closed-question format. Data recorded included demographic characteristics, time from injury to evaluation, pertinent medical history, wound characteristics, type of anesthesia, details of wound-cleansing methods, details of wound closure, and postoperative care. We devised a follow-up tool to evaluate for the presence of infection and short-term cosmetic appearance. Interphysician reliability was assessed for wound description, presence of infection, and cosmetic appearance by use of the kappa statistic. RESULTS: A wound registry data collection instrument that takes less than 1 minute to complete and enables the collection of most wound management techniques used by emergency physicians was found to have substantial interobserver concordance for wound description (kappa range, .55 to .97), wound infection (kappa = 1.0) and overall cosmetic appearance (kappa = .61). CONCLUSION: The wound registry is a reliable data collection instrument that is easy to use. It may be useful as a continuous quality-improvement tool or for standardization of wound surveillance and treatment data to facilitate future prospective studies in wound management.

Adolescent↗
PubMed1995

Effect of inspired oxygen on the cardiovascular effects of protamine after cardiopulmonary bypass.

We have performed a randomized prospective study of the effects of inspired oxygen fraction (FIO2) on the haemodynamic changes after protamine infusion. Thirty-four patients undergoing first time coronary artery bypass surgery were allocated randomly to receive either an FIO2 of 1.0 (group O) or 0.35 (group A) after cardiopulmonary bypass. Before and after infusion of protamine, haemodynamic measurements were obtained, including mean arterial pressure (MAP), mean pulmonary artery pressure, central venous pressure, pulmonary capillary wedge pressure (PCWP), cardiac index (CI), pulmonary vascular resistance index (PVRI) and systemic vascular resistance index (SVRI). In group O, there were increases in mean MAP (8%), PVRI (48%) and SVRI (18%), and decreases in mean CI (10%) and PCWP (15%). Group A showed changes of 0%, -8%, -6%, +3% and +32%, respectively. We found a significant difference between groups in changes in PVRI (P < 0.0001), SVRI (P < 0.01), CI (P < 0.05) and PCWP (P < 0.001). During infusion of protamine, 31% of patients in group O and 6% of patients in group A had a decrease in systolic arterial pressure to less than 80 mm Hg (ns, chi-square test). These observations suggest that FIO2 alters the haemodynamic effects of protamine.

Aged↗
PubMed1995

Poor correlation of short- and long-term cosmetic appearance of repaired lacerations.

OBJECTIVE: To describe the consistency of a cosmetic scale for repaired lacerations and to determine whether the appearance of lacerations at the time of suture removal correlates with the appearance six to nine months later. METHODS: A convenience sample of patients who had lacerations repaired in a university teaching hospital were evaluated at the time of suture removal and six to nine months following repair. All lacerations were assigned 0 or 1 point each for the presence or absence of a step-off borders, contour irregularities, margin separation, edge inversion, excessive distortion, and overall appearance. A total cosmetic score (0-6) was calculated by adding the scores for the categories above. The consistency of the cosmetic scale was assessed by comparison of scores given by two different practitioners evaluating each patient at suture removal and long-term follow-up. The 38 evaluating practitioners were assigned based on availability and did not necessarily perform serial evaluations of the same patient. RESULTS: The 41 participating patients had a median age of 19 years (range, 2-82 years). Wounds were located predominantly on the head (73%) and upper extremity (22%). Long-term follow-up was performed at a median of 219 days (range, 155-280 days) after suture removal. Interpractitioner concordance regarding optimal appearance (score of 6 vs < or = 5) was moderate (kappa = 0.52) at the time of suture removal and substantial at the time of long-term follow-up (kappa = 0.68). However, the correlation of actual scores at the time of suture removal vs at long-term follow-up was poor (r = 0.17, p = 0.29). CONCLUSION: For our clinicians, the six-item categorical scale appears consistent as a tool for the assessment of the cosmetic appearance of wounds. However, correlation between laceration appearance at the time of suture removal and six to nine months later is poor.

Adult↗
PubMed1993

Reduction of acute haemorrhage with aprotinin.

We describe the use of aprotinin in two patients to control life threatening haemorrhage due to coagulopathy when other therapeutic measures had failed. We review the use of aprotinin and give a rationale for its use in acute coagulopathy.

Adolescent↗
PubMed1993

A comparison of effects of fixed and tailored cardiopulmonary bypass flowrates on renal function.

Cardiopulmonary bypass may result in renal impairment but there is little investigative data on the effect of differing flowrates on postoperative renal function. One hundred and twenty-two patients presenting for cardiac surgery were randomly assigned to receive either a fixed CPB flow of 2.4 l.m-2 or a bypass flow tailored to maintain a venous return oxygen saturation of 75-80%. Vasoactive drugs were given to maintain a perfusion pressure of 50 to 80 mmHg. Patients were assessed by serum creatinine, creatinine clearance, arterial blood gases, serum lactates and electrolytes. The results show an overall decline in postoperative renal function compared with preoperative levels, with no significant differences between the two groups.

Aged↗
PubMed1992

The role of blood microfilters in clinical practice.

Blood filters have been available since the 1930s. In this review we evaluate the role of microaggregate filters (MF) in certain transfusion complications, namely non-haemolytic febrile transfusion reactions (NHFTR), pulmonary injury, thrombocytopenia, fibronectin depletion and histamine release. We review the latest generation of leucocyte depleting filters and discuss their role in preventing alloimmunisation, immunosuppression and CMV transmission. Finally, we provide a rationale for the role of blood microfiltration in the present day practice of intensive care medicine.

Blood Transfusion↗
PubMed1992

Perceived credibility of children's sexual abuse allegations: effects of gender and sexual attitudes.

We investigated whether sex role stereotyping, adversarial sexual beliefs, acceptance of interpersonal violence, sex of the subject, characteristics of the child (age, sex), and characteristics of the alleged perpetrator (stranger, father) affect judgments of the credibility of children's reports that they have been sexually abused. Two hundred and fifty-five college students in a 3 x 2 x 2 factorial arrangement were given the Burt (1980) scales and asked to read a short vignette in which a child alleged that he/she was sexually abused and the accused male denied the abuse. Although the vast majority of subjects indicated that they believed the child was telling the truth, females rated the child's credibility significantly higher than males F(1, 253) = 6.29, p = .01226. No other significant relationships were found. The results imply that the vast majority of individuals in a college sample tended to believe children's sexual abuse allegations and that this credibility assessment is not influenced by characteristics of the child or perpetrator examined in this study. Implications of the truncated range of the dependent variable and of the Burt scales are discussed.

Adolescent↗
PubMed1991

Epidural infusion of diamorphine with bupivacaine in labour. A comparison with fentanyl and bupivacaine.

We have compared the analgesic effects of three epidural infusions in a randomised, double-blind study of 61 mothers in labour. An initial dose of bupivacaine 0.5% 8 ml was followed by either bupivacaine 0.125%, bupivacaine 0.125% with diamorphine 0.0025% or bupivacaine 0.125% with fentanyl 0.0002%. All infusions were run at a rate of 7.5 ml/hour. Analgesia was significantly better in both the groups receiving opioids. Diamorphine was shown to be the more effective supplement to bupivacaine. The 5% incidence of pruritus in the opioid groups was less than that reported by earlier authors.

Analgesia, Epidural↗
PubMed1990

Postoperative sore throat. A comparison after premedication with papaveretum/hyoscine or temazepam.

A randomised double-blind trial was conducted to study the use of two commonly used premedication regimens and the subsequent incidence of sore throat. Fifty adult patients who underwent routine surgery were anaesthetised in a standard fashion after premedication with papaveretum and scopolamine or temazepam, and interviewed after operation to assess the presence of sore throat. A significantly higher incidence of sore throat was associated with the use of papaveretum and scopolamine.

Adult↗
PubMed1988

Overlapping T cell antigenic sites on a synthetic peptide fragment from herpes simplex virus glycoprotein D, the degenerate MHC restriction elicited, and functional evidence for antigen-Ia interaction.

Analysis of the B10.A T cell response to synthetic peptides representing the NH2-terminal 23 amino acids from the HSV glycoprotein D sequence revealed two antigenic determinants for T cells: one localized between residues 1-16 and the other between residues 8-23. The 1-16 site, which is helical, was recognized in the context of the Ia molecule, whereas the 8-23 site, which is nonhelical, was recognized in the context of the I-E molecule. The I-E-restricted response was found to be highly MHC degenerate in that T cell hybridomas specific for the 8-23 peptide responded to antigen on APCs derived from B10.A, B10.A(5R), and B10.A(9R) mice and showed differences in antigenic fine specificity with APCs of different haplotypes. These data support the idea of antigen-Ia interaction.

Amino Acid Sequence↗
PubMed1988

Success in old and new licensure examinations: pre-admission factors and academic performance.

Relationships of student and academic variables with nursing licensure examination scores were examined. During the years 1978-1984, 164 graduates of an integrated baccalaureate program took the old State Board examination and 159 took the new examination. Among the pre-admission variables, gradepoint average and student age were most useful in predicting exam scores. Nursing lecture courses were better predictors of success than clinical courses. Students who received A-grades in lecture courses scored relatively higher and B-students scored lower on the new licensure examination compared to the old examinations. Compared with their classmates, students entering the program as LPNs did markedly better on the new licensure examination than they did on the old examinations.

Achievement↗
PubMed1988

A simple technique to distinguish rat from mouse chromosomes in T cell hybridomas.

Antigen-specific rat mouse T-cell hybridomas, prepared by fusing the BW5147 AKR thynoma with helper T cells from rats immunized with chicken ovalbumin, express both the rat and mouse major histocompatibility complex gene products. Using these functionally defined T-cell hybridomas, we have devised a technique based on the differential staining of the heterochromatin region of the rat and mouse chromosomes to distinguish the species of origin of the chromosomes. This technique should prove useful for screening potential hybrid cell lines and should aid in differentiating mouse from rat chromosomes for gene mapping studies.

Animals↗